Assisted living is often used as a blanket term to refer
to any type of residence that caters to seniors. The
reality, however, is that assisted living encompasses a
variety of facilities, with some important distinctions.
Understanding the differences is key to finding one that
best suits your needs or your loved one’s.
In Wisconsin, the state sanctions three
types of assisted-living facilities: community-based
residential facilities (CBRF), residential care
apartment complexes (RCAC) and adult family homes (AFH).
A CBRF is a place where five or more
unrelated people live together in a community setting.
Services are limited to room and board and assistance
with activities of daily living, including toileting,
dressing and bathing. Three hours of nursing care per
week is occasionally included too. According to the
Wisconsin Department of Health Services, CBRFs range in
size from five to 257 beds, and the minimum age
requirement for residing in a CBRF is 18 years. In
addition to the elderly, residents can include people
suffering from dementia, developmental disabilities,
mental health problems, physical disabilities and
traumatic brain injury, among others.
“Per CBRF licensure guidelines, if a
resident requires more than three hours of skilled care
per week, they would need to transition to a skilled
nursing facility. Skilled nursing facilities offer
licensed nurses, physical and occupational therapists,
(and) audiologists, and can provide emergency,
restorative or rehabilitation care, including
intravenous medicines, feeding tubes, etc.,” says Debbie
Harry-Miller, vice president of sales and marketing at
Heritage Senior Living.
The Wisconsin Department of Health
Services defines an RCAC as an independent apartment
complex where five or more adults reside. Sizes of RCACs
in Wisconsin vary from five to 109 individual
All apartments are required to have a
lockable entrance and exit and must include a kitchen,
individual bathroom, and sleeping and living areas.
Residents receive up to 28 hours of services per week,
and services vary from general housekeeping and
transportation to community services and recreational
activities to daily activities like dressing, eating,
bathing and grooming. Nursing services include health
monitoring, medication administration and medication
management. An RCAC must also provide emergency
assistance 24 hours a day.
“The primary difference between CBRF and
RCAC is that an individual can have an activated power
of attorney upon admission to a CBRF, but not to an RCAC.
If a senior is already residing in an RCAC and needs to
activate their power of attorney, they can do so and
stay in the RCAC. It’s only at initial admission that
it’s an obstacle,” explains Adele Lund, director of
business and community relations at the Laureate Group.
Finally, an AFH facility is limited to
three or four adults who receive care, treatment or
services above the level of room and board. The limit
requires that a maximum of seven hours per week of
nursing care be provided.
Memory Care Centers
Many assisted-living communities have
specific memory care units designed for individuals
suffering from Alzheimer’s disease and other types of
dementia. These facilities can be found within all
levels of senior living. The key is determining the
degree and type of memory loss. Typically, assisted
living serves a population of early and mid-stage
dementia, whereas late-stage patients are moved to a
nursing home. Some memory care assisted-living
residences are secure areas equipped with wander
management technology, which assists those suffering
Continuum of Care Facilities
These facilities run the spectrum — with
independent-living apartments, adult day services,
skilled nursing, rehabilitation services and even
hospice services. “A continuum like this provides peace
of mind for the entire family, knowing that services are
available if and when they are needed,” says Carey
Bartlett, vice president of client relations at the
Lutheran Home & Harwood Place.
When deciding which facility best suits
your needs, think long term. “Consumers need to
understand what their loved ones’ specific needs are —
both today as well as what the future may hold based
upon their diagnosis,” Lund says. “When touring a senior
community, find out what the depth of the care is they
provide. What happens if the care needs change? At what
point would they no longer be able to meet their needs?
These are questions that have to be answered.”
Bartlett says that finding the right
place can be overwhelming, but she warns that waiting
for a crisis to occur before studying your options is a
mistake. “When working in crisis mode, decisions are
made quickly and often without all the pertinent
information,” she explains. “In the worst-case scenario,
your family will have to make the selection for you.
It’s best to start the search when you are healthy and
able to drive the process. The goal is to select a
community that offers the lifestyle you envision with
the right blend of services to support your independence
as you age. And plan on it taking anywhere from six
months to two years to find the right fit for you.”